Supporting mums’ mental health strengthens ‘protective’ playmate role with children

The finding comes from a granular analysis of 3,600 five-second clips, which researchers took from recordings of 60 mother-toddler pairs playing together. Mothers with minimal anxiety were more likely to play ‘pretending’ games with their children. Similarly, even when compared with the children of mothers with only moderate levels of anxiety or depression, those whose mothers had no such mental health challenges spent around 10% more time engaging in make-believe play.

The study focused on pretend play because this helps young children to develop essential social and emotional skills. If those skills are less well-developed, they may experience difficulties as they get older: for example, when trying to make friends or settle in at school. This can, in turn, impact further on behavioural development.

Tellingly in this context, the researchers also assessed the children for signs of behavioural problems two years after the first part of the study, and found some evidence that these were less common among children whose mothers engaged in more pretend play when they were toddlers.

Dr Zhen Rao, from the Centre for Research on Play in Education, Development and Learning (PEDAL), at the Faculty of Education, University of Cambridge, said: “Parents are usually their child’s first play partners, so they fulfil an essential role, through pretend play, in helping children to learn skills like how to communicate, control their emotions, and co-operate with others. The associations we found show that supporting families affected by mental health challenges may also enhance children’s access to this important form of play.”

Paul Ramchandani, Professor of Play in Education, Development and Learning at the University of Cambridge, said: “After more than a year of the COVID-19 pandemic and repeated lockdowns, we know that parental anxiety is rising. Now, even more than usual, it is critical that parents who are struggling with depression or anxiety receive appropriate support. As this study indicates, in the long run, it could significantly benefit their children, as well as them.”

According to Public Health England, around one in three children live with at least one parent reporting symptoms of emotional distress. Little is known, however, about how this affects parent-child play, and whether a resulting deficit in certain types of play affects the child’s development.

For the study, researchers worked with the families of children aged between 24 and 36 months. All of the children involved were selected because routine health assessments had indicated that they were potentially vulnerable to developing behavioural problems.

The parents were given a bag of toys and asked to play with their child ‘as they normally would’. Five-minute video recordings were made of each mother-toddler pair, and these were then split into five-second clips. The researchers documented instances of pretend play by both the mothers and children: for example, moments when they pretended to be eating food using a toy picnic set, or created make-believe characters using puppets.

The research also used a series of standard questionnaires, both at the outset and two years later, to measure maternal depression, maternal anxiety, and child behaviour problems. Anxiety was scored on a scale of 0-21 and depression on a scale of 0-27. Behaviour problems were documented using the Child Behaviour Checklist (CBCL).

In general, the researchers found that when mothers engage in more make-believe play, their children do as well. They also found that mothers with higher levels of anxiety do this less, although there was no similar association among mothers with depression.

The results also suggested, however, that children engage in more make-believe play if their mother has lower depression or anxiety. Overall, child pretend play fell by 1% for every unit increase measured in maternal anxiety, and similarly by 1% for every unit increase in maternal depression. Children whose mothers had ‘moderate’ anxiety (10-14 on the 0-21 scale) therefore typically engaged in imaginative pretend play for around 10% less time than those of mothers with no anxiety issues.

“This means that if there are two mothers who pretend play with the same frequency, but one has higher anxiety or depression level, the child of that parent will tend to engage in less pretend play,” Rao said.

The study also found some limited evidence that children whose mothers engaged in more pretend play were less likely to exhibit behavioural problems two years later. The children’s CBCL scores at the two-year follow-up fell slightly for each 1% increase documented in the mother’s pretend play at 24-36 months. This suggests that pretend play may be a protective factor preventing the development of behavioural problems in children.

Further research is required to explain exactly why maternal depression and anxiety may cause children to engage in less make-believe play, but there are several potential explanations. For example, parents struggling with mental health challenges may be less likely to notice when a child is trying to engage them in a pretend activity, or may simply feel too negative to join in.

While the researchers stress that pretend play is only one mechanism through which maternal mental health may impact on children’s outcomes, it may also be relatively easy to address. “Ideally, of course, we want to reduce anxiety and depression in the mothers, but we may also be able to provide advice or tools which support pretend play and reduce the risk of adverse outcomes for their children,” Rao said.

The findings are published in the journal BMC Psychology.